A Required, Regional Community-based Clerkship

School of Medicine, Family Medicine

An Experiment in Problem-Based Distance Learning for a Required, Regional Community-based Clerkship

The Family Medicine Clerkship, which places students in community-based teaching sites throughout the five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho), will combine local teaching with distance learning through the development of both a new curriculum and innovative technological teaching methods. Content for the new curriculum addresses three issues: the changing US health care system, health care issues at the end of life, and the role of spirituality and medicine. Problem-based learning will use a conferencing feature of an intranet e-mail system which simulates real-time group experience and, having the advantage of being asynchronous, allow students in different time zones and with different practice hours to communicate with one another.

Contact:	Tom Greer Co-Coordinator, Family Medicine Clerkship Associate Professor, Family Medicine tomgreer@u.washington.edu Patricia Stern Co-Coordinator, Family Medicine Clerkship Education Coordinator, Family Medicine pstern@u.washington.edu
Allocation:	$77,082
Date Funded:	October 1998

PROGRESS REPORT
June, 1999

The clerkship team identified three curricular topics to be delivered via the asynchronous problem-based learning format. The three topics include: (1) palliative care and end-of-life issues; (2) changing U.S. health care system; and, (3) spirituality and medicine.

During the initial seven months of this project, team efforts focused upon the palliative care and end-of-life issues curriculum. Proposal objectives were achieved in the following areas: (1) identification and development of curricular materials on palliative care and end-of-life issues; (2) faculty development on palliative care issues; and, (3) development of an asynchronous problem-based learning template.

FINAL REPORT: November 1, 1998 -October 31, 2000

Goals:

Teach faculty and students about three important contemporary issues not formally addressed elsewhere in our medical school's clinical curriculum: the changing US health care system, health care issues at the end of life, and the role of spirituality and medicine.
Reinforce self-directed learning and familiarity with new technologies through the use of Web resources and private asynchronous e-mail discussion groups for problem-based learning.

Faculty Development Methods:
On-going faculty development was provided at End of Quarter (EOQ) meetings for 24 Clerkship site coordinators representing a five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho). The following presentations were offered to faculty and rated by the majority of site coordinators as very helpful:

March 1999 EOQ Meeting -- Palliative Care Issues (Life Before Death) conducted by Dr. Stuart Farber using a participatory visualization exercise.
June 1999 EOQ Meeting -- Teaching Palliative Care and End of Life Issues by Dr. Stuart Farber
October 1999 EOQ Meeting -- Spirituality by Dr. Stuart Farber
March 2000 EOQ Meeting -- The Changing US Health Care System (Helping Students Understand and Adapt) Dr. Russell Maier and Dr. Hal Clure using case presentations and small group exercises.

EOQ presentations are summarized and included in Highlights which is a quarterly publication. Highlights is produced in paper and at posted electronically at this website to ensure that all site faculty have access to its contents. The paper version of Highlights is distributed at EOQs. As of Spring 2000, the Virtual Clinic website was opened to Clerkship faculty. Faculty were provided with access to the didactic sessions or case presentation, timeline, charts and genogram; however, they were not provided with access to the student discussion groups in order to preserve student confidentiality. Faculty were provided with two hands-on lab sessions at EOQs (Spring and Autumn 2000) to: teach them how to use the Virtual Clinic, answer questions and listen to their concerns, and solicit their ideas for further development of the Virtual Clinic.

Student Teaching Methods
The Virtual Clinic was officially opened on July 19, 1999. It is operated using First Class, an intranet system, which allows students to participate in an electronic conference in an asynchronous mode. The Virtual Clinic uses a single case to teach students about palliative care, pain management, spirituality, and the changing US health care system. The unique structure of the Virtual Clinic also allows students to explore self-directed learning skills such as critical thinking, using the internet as a resource, posing questions, and collaborative learning.

The Virtual Clinic is offered to all third-year medical students as part of the required Family Medicine Clerkship -- in 24 sites located in five states. The Virtual Clinic is offered 8 times per year and sessions operate for three weeks with the fourth week serving as conclusion week. Students in each of the 8 sessions are divided into three smaller clinic groups, which are moderated by Family Medicine Faculty. The small group size (of approximately 8 students) encourages email dialogue and interaction. Since the Virtual Clinic was created, 170-180 students per year have participated in it.

Students are encouraged to use web resources to respond to tasks. Two resources have been designed to facilitate this: a guide and practice exercises for using the Healthlinks Care Provider Toolkit. This guide provides medical students with a practical, opinionated guide to help students locate a wide array of web resources to assist them in caring for patients. It rates sites by three categories: information students want quickly while working with patients, more detailed information on how to take care of patients, and in-depth information to increase student's medical knowledge base. The Practice Exercises for using the Healthlinks Care Provider Toolkit help students hone their skills in navigating the web and learning where to find different types of medical content for specific medical problems.

Evaluation
The student evaluation of the Clerkship was expanded to also include an item on the Virtual Clinic. In academic year 1999/2000, the Virtual Clinic's mean rating was 4.12 [between 4 (good) and 5 (very good) with a 1-6 point scale with 6 as excellent] with a response rate of 91% (N=144). We continually look for ways to improve the quality of the Virtual Clinic by conducting focus groups, administering student surveys, and arranging for a usability review of the Virtual Clinic. This has resulted in improvements to: the site, resources provided to faculty, and the content.

Dissemination:
Our efforts to inform the university community about our project have also been successful. During the past year a front-page Daily article described our project. The Health Sciences News and Information Service email newsletter and website have carried information as well. We demonstrated the Virtual Clinic at a medical school regional conference in June 2000. We have presented some of our evaluative information at a medical informatics seminar (MEDED 590A-HSMGT 526A) in November 2000, and we are slated to present a ninety-minute seminar on our Virtual Clinic Project at the annual Society of Teachers of Family Medicine Predoctoral Conference in California during February 2001.

Tools for Transformation Funded Proposals